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PubMed1984

Women and work: an investigation of the association between health and employment status in middle-aged women.

Considerable controversy has appeared in recent epidemiological literature on the association between unemployment and health. Other recent research suggests that there is an association between women's employment status and their physical and mental health. Although the nature of this association has still to be specified, it is of increasing importance given the dramatic rise in work force participation in the last few decades. This paper analyzes the results of the first large U.S. epidemiological study of the menopause in over two decades, comprising a random sample (n = 8114, response rate = 77%) from the general population of women aged 45-54 in Massachusetts. Women who were employed for pay (69%), full time homemakers (24%) and women who were unemployed themselves (5%) or living with an unemployed spouse (2%) were included in this analysis of data from the cross-sectional phase of the study. Comparisons between a variety of measures and employment status are reported, as are the intervening effects of sociodemographic variables and social support measures. The importance of the 'healthy worker effect', especially for homemakers, is analyzed. Finally, a small subsample of recently unemployed women from the first round of the longitudinal phase of the study is analyzed to demonstrate additional information to be gained through a longitudinal design.

Cross-Sectional Studies↗
PubMed2004

Women's employment status and mortality: the atherosclerosis risk in communities study.

BACKGROUND: As women's labor force participation in the United States has increased over the past decades, there has been an interest in the potential health effects of employment. To date, however, research findings have been contradictory. METHODS: Thus, the aim of this study was to investigate the association between employment status and mortality among 7361 middle-aged African American and white women who participated in the Atherosclerosis Risk in Communities (ARIC) Study. Women were classified as employed or homemakers at the baseline examination (1987-1989) and were followed for approximately 11 years. Proportional hazards regression was used to estimate unadjusted and adjusted hazard ratios. RESULTS: After adjusting for sociodemographic factors and selected risk factors for mortality, employed women had a lower risk of mortality than homemakers (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.49, 0.86). This decreased risk of mortality persisted in additional analyses that excluded those who died within the first 2 years of follow-up or, alternatively, those with a history of coronary heart disease (CHD), stroke, cancer, hypertension, diabetes, or a perception of fair or poor health at baseline. In cause of death-specific analyses, the mortality advantage among employed women persisted for circulatory system-related deaths; however, the association for cancer-related deaths was weaker, and the CI included one. CONCLUSIONS: As the association between employment status and mortality was not explained by known risk factors for mortality, additional research is needed to identify other potential factors that may help to explain this relationship.

Black or African American↗
PubMed1986

Heart rate, employment status, and prevalent ischaemic heart disease confound relation between cereal fibre intake and blood pressure.

Cross sectional data from a survey of 2512 men aged 45-49 years were used to examine the confounding effects of heart rate, employment, and ischaemic heart disease (IHD) on the relation between cereal fibre intake and blood pressure. Daily cereal fibre intake (g/day) was associated with systolic pressure (r = -0.053, p less than 0.01), diastolic pressure (r = -0.057, p less than 0.01), and heart rate (r = -0.071, p less than 0.01). The associations were strengthened in employed men and inapparent in unemployed men. Unemployed men had more IHD than employed men. Persons with any manifestation of IHD had significantly higher blood pressure and heart rates but ate less cereal fibre (7.0 v 7.9 g/day, p less than 0.001) than those without IHD, regardless of employment status. In employed men, after adjustment for age, body mass index, prevalent IHD, and heart rate, systolic pressure changed -0.186 mmHg (95% CI = -0.362, -0.009) and diastolic pressure changed -0.111 mmHg (95% CI = 0.228, 0.005) for each gram of cereal fibre eaten daily. The association between cereal fibre and blood pressure was inapparent in unemployed men. Heart rate, employment, and prevalent IHD confound the association between cereal fibre intake and blood pressure. Future work concerning this relationship will have to account for the effects of these variables.

Blood Pressure↗
PubMed1999

The employment status of 1995 graduates from radiation oncology training programs in the United States.

PURPOSE: To quantify the employment status of 1995 graduates of radiation oncology training programs in the United States. METHODS AND MATERIALS: All senior residents (149) and fellows (36) who completed training in 1995 were mailed an employment survey questionnaire by the Association of Residents in Radiation Oncology (ARRO). Telephone follow-up of nonrespondents achieved a 100% response rate. Twenty graduates who chose to continue training and five who returned to their home countries were removed from the study. Of the 160 who attempted to enter the U.S. workforce, 106 were men and 54 were women. Initial job status and job status at 6-8 months following graduation were determined. RESULTS: Unemployment was 6.9% at graduation and 4.4% at 6-8 months. Underemployment (part-time employment) was 10.6% at graduation and 11.9% at 6-8 months postgraduation. Of those working part-time 6-8 months after graduation, 63% (12 of 19) did so involuntarily after unsuccessfully seeking full-time employment. For the 20 graduates who chose to continue training with fellowships, seven (35%) did so solely to avoid unemployment, four (20%) were partially influenced by the job market, and nine (45%) were not influenced by the job market. Adverse employment search outcome was defined as being either unemployed as a radiation oncologist or involuntarily working part-time. Excluding those who chose to work part-time, a total of 19 (11.9%) graduates at 6-8 months following graduation, compared to 22 (13.8%) at graduation, were either unemployed or involuntarily working part-time. In terms of gender, this represented 18.5% (10 of 54) of females and 8.6% (9 of 105) of males. In terms of geographic restrictions in the job search, 56% of males and 70% of females with an adverse employment outcome limited their job search to certain parts of the country. This compares to 62% of all graduates in this study with geographic restrictions in their job search. In terms of perceptions of the workforce and employment opportunities, 95% of all graduates believed there was an oversupply of radiation oncologists and 95.5% believed the job market was worse than what they had anticipated on entering training. Only 42.8% of all graduates were satisfied with the job opportunities available to them. A significant number of private practice positions (41%) did not offer a partnership track, and those that did so had an increased median employment period before partnership (3.25 years) compared to previous years. CONCLUSION: This is the only employment survey for any specialty in which a 100% response rate was achieved. Upon graduation, a significant number of residents and fellows were either unemployed or involuntarily underemployed. The job market absorbed only a fraction of them at 6-8 months. Most graduates, including those employed full-time, were not satisfied with the practice opportunities available to them during their job search. Many private-sector jobs did not offer a partnership track, and those that did required an increased employment period. A higher rate of involuntary part-time employment was seen for female graduates. Geographic restrictions in job search alone could not account for graduates being unemployed or underemployed, and could not account for gender differences. An overwhelming majority of 1995 radiation oncology graduates believed that the job market had deteriorated and that there was an oversupply of radiation oncologists. As one of two major studies tracking the employment status of radiation oncology graduates, we believe this study to be superior in methodology. We also believe this study presents data in a manner useful to medical students, training program directors, and healthcare policymakers.

Employment↗
PubMed2004

Self-rated health and employment status in chronic haemodialysis patients.

OBJECTIVE: Along with survival and other types of clinical outcome, physical, mental and social well-being are important indicators of the effectiveness of the medical care that haemodialysis (HD) patients receive. The present cross-sectional study was designed to assess self-rated health in HD patients from a large Danish HD centre compared to a Danish general population sample with similar sex and age distributions. Furthermore, employment status and associations between self-rated health and clinical, social and demographic factors were investigated. MATERIAL AND METHODS: A total of 150 patients were included. They were asked to complete the Short Form 36 (SF-36) questionnaire and additional questions concerning education and employment status. The SF-36 consists of eight scales representing physical, social, mental and general health. Clinical, biochemical and dialysis adequacy data were obtained from hospital records. RESULTS: A total of 112 patients completed the questionnaire, giving a response rate of 75%. Compared to the general population sample, HD patients scored significantly lower on all eight SF-36 scales (p < 0.01), with the greatest difference being observed for items concerning physical functioning. No correlation was found between any of the eight scales and estimates of dialysis adequacy. Of patients aged 18-60 years, 22% were in employment. CONCLUSION: In a large group of Danish HD patients, self-rated health (and especially physical function) was found to be substantially impaired compared to the general population and only a small proportion of patients were employed. We believe that results obtained using the SF-36 questionnaire represent an independent marker of health status in HD patients and should be considered, together with common clinical outcome measures, when monitoring patients. Furthermore, we believe that self-rated health questionnaires are a useful tool for evaluating the need for and the effects of physical activity programmes in a dialysis unit.

Adult↗
PubMed1995

Predicting subsequent employment status of SSA disability applicants with chronic pain.

OBJECTIVE: The study assessed the predictive ability of the standardized Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). An assessment tool that predicts return to work with chronic pain patients is needed, as increasing numbers of disability applications are adjudicated in the courts. DESIGN: National randomized validation sample of disability applicants. Each MMPAP consisted of physical examinations by two physiatrists and the participant's subjective assessment. Criterion standards were Multidimensional Pain Inventory and McGill Pain Questionnaire. There was phone follow-up 6 months postdecision. SETTING: Six clinical sites were ambulatory referral centers, both public and private. PARTICIPANTS: Population-based random national sample of 710 Social Security disability applicants claiming chronic pain related to their disability, stratified by national Social Security Administration (SSA) applicant demographics. Seventy-eight were lost to follow-up, and 688 initially refused. INTERVENTIONS: No interventions were continued or initiated by the research team between assessment and follow-up. MAIN OUTCOME MEASURES: Claimant employment status 6 months after disability decision was primary outcome, change in pain intensity, and change in employment situation. RESULTS: The MMPAP predicted with 90% accuracy employment status of SSA disability applicants with chronic pain 6 months postdecision when assessed at application by two physicians trained in Physical Medicine and Rehabilitation (physiatry). Accuracy of employment situation change was 93%, and pain intensity change was 65%. Self-report measures, physical examination results, psychological status, functional limitations, and physician's subjective appraisal predict future employment. CONCLUSIONS: The MMPAP accurately predicts future employment of disability applicants claiming chronic pain. The introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.

Chronic Disease↗
PubMed1995

Prediction of employment status 2 years after traumatic brain injury.

The present study used a multivariate approach to investigate which of a range of variables relating to demographic factors, injury severity and degree of disability on admission to rehabilitation were the best predictors of employment status 2 years after traumatic brain injury (TBI). Subjects were 74 TBI patients who had been working prior to injury, had undergone rehabilitation at Bethesda Hospital and attended a review clinic 2 years after injury. A cross-validation sample consisted of a further 50 such subjects. Following preliminary analysis four input variables were selected: age under or over 40 at time of injury, Glasgow Coma Scale score on acute hospital admission, duration of post-traumatic amnesia and total score on the Disability Rating Scale (DRS) on admission to rehabilitation. Stepwise discriminant function analysis resulted in a discriminant function consisting of three variables--total score on the Disability Rating Scale, Glasgow Coma Scale Score and age--which correctly classified 74% of grouped cases. A second analysis using the original discriminant function correctly classified 68% of the cross-validation sample. Chi-square analysis showed no significant difference between these results, thus confirming these variables, in combination, as predictors of employment status 2 years after TBI.

Activities of Daily Living↗
PubMed2005

Factors related to employment status changes in individuals with multiple sclerosis.

In a sample of 50 individuals with multiple sclerosis (MS), participants able to work full-time ('W'), those who reduced their hours ('CB') and those who were unemployed ('NW') were compared on demographic and disease variables and symptoms that the participants identified as being responsible for their work status change. The NW group had significantly greater physical disability than the other two groups and significantly more fatigue than the W group. The CB group had significantly more years of education and higher occupational prestige ratings than the NW group. The W group reported significantly greater mood disturbance compared with the NW group. Employment status was unrelated to age, gender, full scale IQ estimate, disease duration, diagnosis duration or cognitive functioning. Ninety per cent of the CB group reported that fatigue was a primary symptom responsible for their work status change, whereas 86% of the NW group reported that broad physical/neurological symptoms were responsible for their change in work status.

Adult↗
PubMed1984

Child adjustment as related to financial security and employment status of fathers with spinal cord injuries.

Many rehabilitation professionals have expressed concern about the effects that socioeconomic changes associated with disability in a parent have on children's adjustment. It has been speculated that financial insecurity and unemployment among fathers with disabilities adversely affect child development, because of the presumed consequence of reversal in parental roles. This study tested these notions by comparing children whose fathers with spinal cord injuries (SCI) were: (1) receiving ample, secure income vs low income that was not guaranteed, and (2) employed vs unemployed. All subjects were given seven tests measuring personality, values, and interests, which were completed in a standardized order and time period. On 16 demographic indices and more than 150 measures of children's personality, behavior, and attitudes, only 17 were related to the financial resources of fathers with SCI and 11 to their employment status. Contrary to opinions in previous reports, no adverse relationships were found between child adjustment and the financial security or employment status of fathers with SCI. Limitations and implications of the study are discussed.

Adolescent↗
PubMed2005

Employment status and quality of life in patients with chronic obstructive pulmonary disease.

OBJECTIVES: Recently, the conditions for disability benefits were redefined in several countries, stimulating employees to participate on the labour market as long as reasonably possible. Little is known of labour participation and quality of life (QoL) of employees with chronic diseases. This study examines the associations between employment status and QoL in COPD patients. Additionally, the role of lung function, and work-related symptoms and exposures on QoL were explored. METHODS: Secondary analyses were conducted on baseline data from a randomized control trail. Patients were categorized as: "paid-workers"; "voluntary non-paid workers" (e.g., early retired, house wives) or "disabled for work". QoL was assessed by the Chronic Respiratory Questionnaire (CRQ). Between-group differences in CRQ scores, and associations between work-related symptoms or irritants and CRQ scores were uni- and multivariately analysed. RESULTS: Two hundred and ten patients with COPD were included [mean age 53.9 (SD 6.8) years, FEV(1) %predicted 63.5 (SD 18.5)]. No statistically significant differences in lung function between the employment status subgroups were observed. Multivariable analysis showed that the "disabled" had lower CRQ scores as compared with "paid workers" (0.52 point difference, p<0.001). The CRQ scores of "voluntary non-paid workers" were not significantly different from "paid workers". Within the group paid workers, patients with many work-related clinical symptoms and being susceptible to various work-related irritants experienced a lower QoL than patients who had respectively no symptoms, or who were not susceptible to these factors. CONCLUSIONS: Patients with COPD who were disabled for work showed equal severity of airflow limitation but worse QoL, as compared with paid workers.

Persons with Disabilities↗
PubMed2005

Educational needs and employment status of Scottish dental technicians.

OBJECTIVE: To investigate the educational needs and employment status of dental technicians in Scotland. SUBJECTS: Two hundred and fifty dental technicians with postal addresses in Scotland. DESIGN: Structured questionnaire. RESULTS: An 83% response rate was achieved following three mailings. The majority of respondents were employed in commercial dental laboratories largely within the 'central belt' of Scotland, with 96% stating they were in full-time employment. Only 33% of these essential health-care workers were voluntarily registered with the Dental Technicians' Association, suggesting that a significant number had not felt it necessary or beneficial to do so. A lack of educational structure was identified, as was poor remuneration and an absence of opportunity for career progression. Although the prospect of continuing professional development was desirable, many respondents reported that they would be penalised financially for undertaking this and, in addition, may not be given the opportunity to pursue education because of lack of co-operation from their employer. Only 47% had attended an educational event within the preceding year, and of those who had not done this, a period of two-32 years had elapsed since any CPD involvement. Of the respondents, only 34% stated that any financial assistance had been available for educational purposes, with access to education being highlighted as problematic by 68%. A total of 64% of subjects felt they were out-of-date with professional education. CONCLUSIONS: This study highlights a number of real and potential problems in the field of education in dental technology. It is apparent that change within the structure of education and professional status, although largely welcomed, may be difficult to implement. The profession, as a whole, must realise that these changes in education and employment are not optional, and should be embraced as a positive step which will hopefully raise the profile and status of dental technicians throughout the UK.

Certification↗
PubMed2004

Self-assessed changes in mental health and employment status as a result of unemployment training.

The main question addressed in this article is: What factors in an unemployment programme serve both the individual and society? Our research focuses on background variables and process variables and how these can be assumed to affect certain dependent variables in unemployment training. The current focus is on the dependent variable "subjective assessment of the effect of the training on mental health", together with the more objective dependent variable of "employment status after training". Self-confidence, well-being, faith in the future, level of initiative and personal development have been used as indicators of self-assessed "mental health". Data were collected from an unemployment training programme in Sweden and the variables combined to create a hypothetical model. The model was statistically tested and then modified with the aid of LISREL statistics, which helps to adjust the model to statistical acceptance. The findings show that the salient factors directly related to the subjective assessment of the effect of training on mental health are gender, attitude to skills development, perceived training requirements and formal educational background. The latter relationship was negative. Of indirect importance are the level of commitment of the teacher, the satisfaction of the trainee with the process, and the level of control. The duration of previous unemployment was the only independent variable, which directly affected the employment status after the training, and this was in the negative direction. Of indirect importance for this dependent variable were training requirement, satisfaction with the process, own level of control and attitude to skills development.

Adult↗
PubMedDate not supplied

Life expectancy by employment status, income, and education in the National Longitudinal Mortality Study.

Based on data from the National Longitudinal Mortality Study for 1979-85, life expectancies are estimated for white men and white women by education, by family income, and by employment status. Life expectancy varies directly with amount of schooling and with family income. Differences in life expectancy at age 25 between the highest and the lowest levels of education completed were about 6 years for white men and about 5 years for white women. For family income, differences between the highest and the lowest income groups were about 10 years for white men and 4.3 years for white women. The largest differences in life expectancy were between employment categories. At age 25, white men in the labor force lived on average about 12 more years than those not in the labor force, and white women lived on average about 9 more years. For those who were unable to work compared with those in the labor force, the difference for white men was about 20 years; for white women, 29 years. Results in this study showed much the same differentials in life expectancy for education as the earlier Kitagawa-Hauser study.

Adult↗
PubMed2006

Educational needs and employment status of Scottish dental nurses.

OBJECTIVE: To investigate the educational needs and employment status of dental nurses in Scotland. SUBJECTS: One thousand, seven hundred and thirty dental nurses with postal addresses in Scotland. DESIGN: Structured questionnaire. RESULTS: A 65% response rate was achieved following three mailings. The majority of respondents were employed in the central belt of Scotland although comparatively, substantial numbers were also recorded as being employed in Highland and Grampian regions. A total of 70% of dental nurses stated they were in full-time employment, with 74% of all participants reporting they were qualified. Of those who were unqualified, 17% (n = 191) were not in the process of formal training which may mean they are unable to work in the future, unless they conform to the GDC 'grandparenting' requirements. Induction training had only been received by 34% (n = 377) of this group, and a mere 21% (n = 234) reported regular CPD involvement. Of the 75% (n = 832) who responded to a question on funding for CPD, only 50% (412) received financial assistance. Geographical location for many nurses generated a number of difficulties in accessing education, and the possibility of distance or e-learning was requested by 65% of the sample. CONCLUSIONS: This study demonstrates clearly that there are many well-qualified dental nurses in employment in Scotland. However, unless structured career pathways are developed, access to education is simplified, and the problem of poor remuneration is addressed, then foreseeable problems may arise where there is insufficient enticement to encourage people to join what is an already underpopulated profession.

Dental Assistants↗
PubMed1994

Employment status, non-daytime work and gastric ulcer in men.

BACKGROUND: An excess risk of gastric ulcer (GU) (ICD-8: 531) has formerly been found in shift workers and ex-shiftworkers but little is known about the risk of GU associated with other forms of non-daytime work. This study deals with associations between non-daytime work and GU. METHODS: A fixed cohort of 122,116 men in occupations in which at least 20% had non-daytime work and a reference group of 593,281 men in occupations with daytime work only, was followed in the National Inpatient Register for first discharges with GU as the principal diagnosis. RESULTS: For men with daytime work only we found a steep inverse association between GU and employment status. Men in occupational groups with late evening work had a standardized hospitalization ratio (SHR) of 236 (90% confidence interval [Cl]: 184-299), groups working in rosters covering 24-hour services had an SHR of 147 (90% Cl: 116-183). A slightly raised risk of 114 (90% Cl: 101-128) was found in groups having other forms of non-daytime work. For all men in groups with non-daytime work we found a significant SHR of 130 (90% Cl: 118-142). CONCLUSION: We conclude that both low employment status and non-daytime work are associated with an increased risk of GU.

Adult↗
PubMed1990

Mortality by employment status in the National Longitudinal Mortality Study.

A mortality follow-up of 452, 192 persons aged 25 years or more who were characterized with respect to employment status was conducted using the National Death Index for the years 1979 through 1983. The cohort, part of the National Longitudinal Mortality Study, was drawn from Current Population Survey samples representative of the US population using selected months during the years 1979-1983. Employed persons aged 25-64 years were found to have standardized mortality ratios from 61% to 74% of the average, depending upon their sex and race. Unemployed men had standardized mortality ratios slightly above 100, but these values were 1.6 and 2.2 times higher than those for employed white men and black men, respectively. Those classified as unable to work had very high mortality ratios, from two to seven times the average. In the older age groups, 65 years or more, very low mortality ratios were found for those who were still employed. These relations were maintained after adjustment for family income and educational level. These results 1) describe the magnitude of mortality risk for clearly defined employment categories, 2) identify segments of the population with especially high mortality requiring greater public health recognition, and 3) suggest further research into the health consequences of the various employment/nonemployment conditions.

Adult↗
PubMed1995

Adherence to breast cancer screening guidelines among African-American women of differing employment status.

The purpose of this study was to identify and compare the adherence to breast cancer screening guidelines [monthly breast self-examination (BSE), age-related mammography, yearly professional breast examination (PBE)] among African-American women (AAW) of differing employment status. The Breast Cancer Screening Model served as the organizing framework for this study. One hundred fifty-four subjects were quota sampled according to age and employment group status. Findings showed that 63% of all subjects practiced monthly BSE and 76% had undergone a yearly PBE. Only 20% of all subjects had undergone a mammogram according to the age-related guidelines. Overall, breast cancer screening rates were lower than recommended across all employment groups. Variables that uniquely explained 74% of the variance in monthly BSE included level of education, marital status, social influence, knowledge of BSE, and intention to do BSE in the future. Age group, previous instruction on mammography, income, and perceived barriers related to mammography explained 15% of the variance in age-related mammography. Finally, marital status, previous information on PBE, and intrinsic motivation explained 42% of the variance in yearly PBE. Together, these findings highlight the need for (a) the development of strategies that will promote long-term adherence to all three screening guidelines, and (b) the design of qualitative studies using a representative sample of AAW of differing socioeconomic backgrounds.

Adult↗
PubMed1986

Employment status and psychological well-being: a longitudinal study of 16-year-old school leavers.

The relationship between employment status and psychological well-being is investigated in a longitudinal study of 16-year-old school leavers. Significant differences between employed, unemployed and government training scheme groups on a number of measures of well-being were found, these differences persisting after adjustment for individual differences and for other factors known to affect mental health. Implications for clinical practice and public health are considered and possible explanations for the poorer psychological health of the unemployed group are discussed.

Adolescent↗